NEUROSINE, DIOVIBURNIA, GERMILETUM AND PALPEBRINE
Report of the Council on Pharmacy and Chemistry
Neurosine, Dioviburnia, Germiletum and Palpebrine are “shotgun” proprietaries typical of the polypharmacy of the past three or four decades. They are marketed by the Dios Chemical Company, St. Louis, Mo. On the recommendation of the referee, the Council has authorized the publication of this report.
W. A. Puckner, Secretary.
Neurosine
According to the manufacturers, each fluidounce of Neurosine represents:
“Bromid of potassium, C. P. | 40 | grains |
“Bromid of sodium, C. P. | 40 | grains |
“Bromid of ammonium, C. P. | 40 | grains |
“Bromid of zinc | 1 | grain |
“Extract Lupulin | 32 | grains |
“Cascara sagrada, fl. ex. | 40 | minims |
“Extract Henbane | .075 | grain |
“Extract Belladonna | .075 | grain |
“Extract Cannabis indica | .60 | grain |
“Oil Bitter Almonds | .060 | grain |
| “Aromatic Elixirs.” |
No physician would think for a moment of prescribing all of the drugs contained in Neurosine for any one condition. Yet physicians are urged to use this nostrum in insomnia, hysteria, neurasthenia, migraine, neuralgia, delirium tremens and in a host of other conditions.
It is recommended in the treatment of epilepsy on this ground:
“Neurosine is presented in a very palatable and agreeable form and can be administered for an indefinite time without untoward by-effects as so often attends the use of the commercial bromides. In order to secure lasting benefits the treatment should be extended over a long period of time.”
The evident implication here is that the recognized drawbacks of bromid medication are due to impurities present in the commercial bromids and that the teachings of modern medicine with regard to caution in the use of bromids do not apply in the case of Neurosine.
The assurance is offered:
“Neurosine contains no chloral, morphin or other objectionable drug—a fact of the utmost importance when administering medicines to neurotic women.”
“As a nerve-calmative and sleep-producer nothing can excel Neurosine ... It should be borne in mind that this preparation contains no opium, morphine, chloral or habit-forming drugs ... Neurosine being a harmless remedy is especially indicated for neurotic individuals.”
Apart from cannabis indica, Neurosine contains no efficient hypnotic. Cannabis indica is a dangerous drug, whose administration to “neurotic individuals” is by no means free from danger—especially when it is given under a proprietary name that carries no warning of its presence.
Here is another recommendation—this time for chorea:
“All authorities recommend the bromides, hyoscyamus and cannabis indica in this disease. These remedies are all combined in Neurosine, the ideal calmative for both children and adults.”
On the contrary, practically “all [medical] authorities” will admit that it is undesirable to keep a child under the influence of bromids if this can be avoided. Such treatment is mentioned only for use as a last resort in extreme cases. Hyoscyamus and cannabis indica are mentioned in connection with chorea by few authorities, and then merely as probably valueless.
Not content with recommending the promiscuous use of this already too complex mixture, the Dios Chemical Company advises physicians to combine it with iron, when chalybeate and tonic effects are to be combined with “a nervine,” with acetanilid for “irritable cough,” headache and neuralgia, with antipyrin in asthma and with Dioviburnia—another Dios nostrum—in all female ailments.
Dioviburnia[W]
Dioviburnia, another Dios nostrum, according to the label, has the following composition:
“Every fl. oz. contains 3-4 dr. each of the fl. extracts, Viburnum Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris Farinosa, Helonias Dioica, Mitchellae [sic] Repens, Caulophyllum Thalictroides, Scutellaria Laterifolia.” [Lateriflora?—Ed.]
Further, according to the label, Dioviburnia contains 18 per cent. alcohol. If this statement is correct then the “formula” is false, for the fluid extracts named contain from 25 to 73 per cent. of alcohol. As—according to the “formula”—these fluid extracts constitute three-fourths of Dioviburnia, the average alcohol-content in the whole mixture must of necessity be much above 18 per cent.[59] According to the makers, Dioviburnia is “unexcelled” for:
“Amenorrhea, Dysmenorrhea, Leucorrhea, Puerperal Convulsions, Prolapsus Uteri, Menorrhagia, Threatened Abortion, Parturition, Subinvolution, Miscarriage, and a general relaxed condition of the uterus and appendages, together with the various aches and pains peculiar to women.”
Around the sample bottle of Dioviburnia is wrapped a booklet entitled “A Treatise on Uterine Diseases and Obstetrical Hints,” said to be “For the Profession Only.” The booklet has been prepared, physicians are told, to present “some very valuable suggestions” regarding the treatment of female disorders and the attention of the medical profession is “earnestly” called to the “very remarkable medicine,” Dioviburnia. Further, it is said that Dioviburnia was devised by the Dios Chemical Company because there was an “absolute necessity” for some really efficient internal treatment in female diseases. The company backs up its statements by such claims as:
“The most valuable preparation, therapeutically, ever offered.”
“[Contains] every essential for toning up the female organs of generation, and relieving pain.”
“A general and special tonic, antispasmodic and invigorating cordial.”
While the company directs the attention of physicians to the “well-known, therapeutical effects of each individual constituent” of Dioviburnia, there is in reality little positive evidence regarding the action of any of the drugs contained in the nostrum. Most writers on materia medica do not even mention these drugs and the few who do discuss them, either question or deny their medicinal value. But if every drug claimed to be present in Dioviburnia had some actual demonstrated therapeutic properties, it still would be impossible to predict the action of such a combination in the many and varied conditions for which it is exploited. Certainly there is no warrant for such statements as:
“In Painful Dysmenorrhea [sic] Dioviburnia is especially indicated, and its continued use will invariably give relief.”
“In cases of Leucorrhea of long standing, Dioviburnia, together with local treatment, invariably gives relief.”
“Dioviburnia is efficient in cases of subinvolution; it cures by its tonic effects ...”
The effects of the drugs alleged to be present in Dioviburnia are not such as to justify the hope of either “cure” or “invariable relief.” In a way the Dios Chemical Company seems to recognize the inefficiency of Dioviburnia since it frequently suggests that it be used in combination with drugs of known value; but it ascribes all favorable results to its own product:
“In chronic constipation fluid extract of cascara sagrada aromatic may be combined with Dioviburnia.”
“In cases of habitual abortion, depending on syphilitic taint, a prescription containing the following should be used during the entire pregnancy:
| ℞ “Hydrarg. Chlor. Corros | gr. | 1 |
| “Potass. Iodid | dram | 1 |
| “Dioviburnia | ounces | 16” |
“An Anemic or Chlorotic patient, suffering with absence of the menstrual flow, should take DIOVIBURNIA combined with Iron.”
“In leucorrhea depending on endocervicitis, hot astringent douches once daily should be given. Local applications of iodin are useful in chronic conditions. Internally, Dioviburnia promotes healing.”
“Rest in bed, hot douches of a one-half per cent. solution of compound cresol solution and Dioviburnia internally, a teaspoonful every 3 hours will rarely fail to cure endometritis in a few days.”
“In specific vaginitis, a solution of potassium permanganate (1 to 1000) should be used as a douche twice daily. Internally give the following:
“Sodii benzoate | 1⁄2 | ounce |
“Dioviburnia | 16 | ounces |
| “M. sig., Teaspoonful every three hours.” | ||
“Prolapsus Uteri is benefited, and often cured, by DIOVIBURNIA combined with local treatment in the shape of tampons, pessaries, electricity, etc.”
If Dioviburnia will cure specific vaginitis, anemia, etc., so will a cobblestone make excellent soup. All that is necessary in the former case is to add certain potent drugs that might be indicated in the pathologic conditions mentioned and, in the latter case, to combine suitable amounts of beef, chicken, green turtle or vegetables, with herbs and other seasoning.
Germiletum
Germiletum is a member of the large class of alkaline antiseptic solutions with excessively complex formulas. In this case not only is the formula complex but also the Dios Chemical Company finds it impossible even to assign a constant composition to it—at least the “formulas” which appear on the different styles of Germiletum labels and advertising circulars vary greatly.
The company says:
“We appeal only to the Doctor’s judgment of his estimation of the formula.”
“Doctor you will readily determine from the formula the class of cases in which you have a right to expect satisfactory results.”
Yet the “formulas” given present so great a variety and such confusion that it is not clear even to a chemist just what the Dios Company wants the medical profession to regard as the composition of Germiletum.
The following statements of “composition” have appeared at various times:
1. In an advertising circular sent out some time ago:
“[HBF4 + BOH (OC6H4COOH)2
+ BOH (OC6H3COOH)2 + C3H5BO3
+ CH2O + C10H14O
+ C10H20O + C24H28N3Cl.]”
2. In advertising circulars which have been received of late, being wrapped with a sample package and with the “large size” trade package:
“[C7H6O2 + H3BO3 + C3H5BO3
+ (CH2O)3 + C10H20O + C10H14O + C2H6O]”
3. In another advertising circular:
“Germiletum is a slightly alkaline chemical solution of Borohydrofluoric Acid, Borosalylbenzoic Acid, Boroglycerine, Formaldehyde with Menthol, Thymol and Antiseptic Aromatics.”
4. On the label of a sample package sent through the mails during 1914, and on the label of a “small size” trade package purchased in 1914:
“FORMULA.—Borohydrofluoric Acid, Borosalylbenzoic Acid, Boroglycerine, Formaldehyde with Menthol, Thymol, Amyl Acetate and other Antiseptic Aromatics.”
5. In the circular which was wrapped around the sample package referred to above, and around the “large size” trade package purchased at the same time that the “small size” package was bought:
“Germiletum is a slightly alkaline chemical solution of Borobenzoic Acid, Boroglycerine Formaldehyde, with Menthol, Thymol and other Antiseptec [sic] Aromatics.”
6. On the sample package, on the “small size” trade package and on the wrappers of the “large size” trade package:
“Alcohol 18 per cent.; Formalin 3⁄4 M. per oz.; Amyl Acetate 1⁄3 M. per oz.” (also written “Acetate Amyl.”)
The label on the large trade package states that Germiletum contains “Formalin 1⁄2 M. per oz.”
One and all of these various formulas spell mystery. The existence of some of the constituents is problematic; even if the theoretical possibility of such combinations be conceded, some of them could not exist in Germiletum, for they would be broken up by the alkaline fluid. As illustrating the contradictions which the formulas present: While the wrapper of the “large size” trade package claims that Germiletum contains 3⁄4 minims Formalin (Formalin is a proprietary name for a 40 per cent. formaldehyd solution) the label on the bottle claims only 1⁄2 minim. Again, while the composition expressed in chemical symbols asserts that “H3BO3” (boric acid) is a constituent of Germiletum, the “formula” which follows it states that Germiletum has an alkaline reaction; hence it cannot contain much boric acid. Finally, the “small size” bottle of Germiletum purchased at the same time as the “large size” bottle and also the label of a sample package sent through the mails to a physician in 1914, give as a constituent “Borohydrofluoric Acid,” which is mentioned neither on the label of the “large size” trade package nor in the pamphlet wrapped around it. The only information which these contradictory “formulas” can convey to a physician is that Germiletum is an unscientific, varying mixture of many drugs.
A trade package, having the name “Germiletum” blown in the glass, bears on the label recommendations for its use in the treatment of “catarrh,” “Gastritis, Stomatitis, Gastric and Intestinal Catarrh,” “Leucorrhea and Uterine Diseases,” “Hemorrhoids,” “Whooping Cough,” “Tonsilitis and other forms of sore throat” and “Eczema.”
The following statement on the label is designed to induce physicians to place false confidence in Germiletum to the danger of their patients:
“The lying-in-room should be thoroughly sprayed with Germiletum. Can be relied upon to destroy the living particles which so generally constitute contagion.”
This claim, as well as the assertion which appears on the label of a sample package and of the “small size” trade package that it is “PAR-EXCELLENT IN OBSTETRICAL PRACTICE” is almost criminal, as Fussell[60] has said, since to depend on any preparation of this sort is to court disaster.
The booklet around the trade package makes the claim that Germiletum “is the best antiseptic”—evidently largely because it is claimed to be “the blandest of all”—and that it is “thoroughly germicidal” and even that it is “the best disinfectant obtainable.” It also contains such unwarranted and misleading claims and suggestions as:
“... preparatory to all operative work—Germiletum should be used freely in spraying the atmosphere ...”
“Operative wounds, whether large or small, can be rendered thoroughly antiseptic by freely spraying them with Germiletum....”
“... it may be given internally in many dyspepsias and in all zymotic diseases.... In such conditions Germiletum is the ideal internal antiseptic and disinfectant.”
In the present advertising, no evidence whatever is offered for the value of Germiletum, the Dios Company contenting itself with unsupported claims and cant phrases such as
“... the truth is only reached through a final appeal to intelligent practical experience.”
In the old circulars only crude, uncritical and meaningless tests to establish the antiseptic value of Germiletum are reported and none whatever as to its germicidal action. In the advertising matter sent out some time ago, for instance, were given “Microscopical, Bacteriological and Chemical Tests, Comparing Germiletum with Carbolic Acid.” These tests have no value whatever, unless it be to show the worthlessness of the preparation. This is particularly true as regards a series of experiments on “Germiletum as a Preventive of Lactic Fermentation,” in which one part of Germiletum in thirty parts of milk did not prevent fermentation. Such effect as indicated is probably due to the formaldehyd present. The tests show the absurdity of using the preparation for internal and external purposes. The referee challenges the therapeutic claims on the basis that they are extravagant and unsubstantiated. (The Chemical Laboratory of the American Medical Association reports that the alkalinity of Germiletum corresponds approximately to a 1 per cent. borax solution.)
Palpebrine
According to the Dios Chemical Company, Palpebrine is “A Reliable External Ocular Antiseptic” having, it is said, the following composition:
“... each fluid ounce contains 1⁄116 grain Sulphate of Morphia, 1⁄7 grain Sulphate of Zinc, 1⁄11 grain Bi-Chloride of Mercury, 53⁄8 grains Boric Acid, 3⁄4 grain Salicylic Acid.”
The essential virtues ascribed to Palpebrine, according to its makers, are its harmlessness and its therapeutic efficiency due, presumably, to its complex composition:
“Attention is called to the constituents of this formula, each one of which is used by ophthalmologists. Their combination in Palpebrine is such as to blend their action in a very happy manner. Palpebrine acts as an antiseptic, an irritant, an astringent, and a nerve tonic to the mucous membrane of the eye.”
“Palpebrine is superior in its action to the remedies now in use. It contains all the constituents of Aqua Conradi ... But to these are added a number of other agents which will prove it to be of much greater value and give it a broader field for action.”
In all external afflictions of the eye the free use of Palpebrine is suggested in such statements as:
“They [general practitioners] will therefore gladly receive from our hands an efficacious preparation which may be used with perfect safety.”
“The name of our preparation—Palpebrine, is derived from the Latin palpebra, the eyelid, and is well fitted, as it designates at a glance the sphere of action of Palpebrine.”
“With the assistance of Palpebrine the general practitioner can successfully treat all cases of external eye disease ordinarily encountered in his practice.”
One of the members of the Council staff of clinical consultants calls attention to the fact that much vitally valuable time might be lost in a case of iritis, for example, which being unrecognized, should be treated with Palpebrine on the strength of the Dios Chemical Company’s advertisements. Even more dangerous is the recommendation of Palpebrine for the prevention of ophthalmia in the newborn, especially as this recommendation is coupled with an attempt to discredit the established treatment with silver nitrate solution:
“The use of severe remedies for this purpose has been discarded by most physicians....”
While it is doubtless true that ophthalmia neonatorum may be averted by other drugs than silver salts, it is utterly unjustifiable to suggest that the established method of treatment by means of silver salt irrigations has been generally discarded.
[Editorial Note.—The four nostrums mentioned above have been grouped together for publication to call attention to one phase of the proprietary business. A fact not mentioned in the Council’s report is that these nostrums are manufactured and promoted by a concern that belongs to a type we have often designated “pseudo-chemical” companies. By this is meant companies that are not in the legitimate business of pharmacy or chemistry, but organized to exploit one, two or in some instances half a dozen proprietaries. “Patent medicines” are exploited by this class of “companies.” The Dios Chemical Company is not a chemical company, except in name. J. H. Chambers, the founder so far as we can learn, never claimed any special knowledge of chemistry, pharmacy or medicine. The officers at the present time are: J. H. Chambers, president; M. E. Chambers, vice-president; Leslie T. Chambers, treasurer, and Arthur Chambers, secretary. M. E. is the wife of J. H., and Leslie T. and Arthur are sons.
This is simply one illustration of the fact noted above. Some physicians have been and are prescribing nostrums originated, manufactured and advertised by laymen who are not in the legitimate pharmacy business. In addition, such physicians have been accepting the statements of laymen, not only as to the composition of the nostrums, but as to their use. In every state the practice of pharmacy is regulated by law: before assuming the responsibility of compounding medicines a druggist must have studied and passed an examination in pharmacy. Public safety demands and the law requires it. There are some doctors, however, who will allow laymen who are not chemists, pharmacists or physicians to formulate and compound a prescription and tell them what it is good for and how to use it.
The Dios Chemical Company is not an isolated instance: we have already referred to some; we shall take occasion to refer to others in the future. That such concerns flourish is a reflection not so much on the shrewd laymen who exploit the medical profession—and through it the public—as it is on the physicians who cast their scientific training to the winds and permit themselves to be thus exploited.]—(From The Journal A. M. A., Jan. 9, 1915.)